The Negative Impact of E-Cigarette Use on Heart Health

by Rachael Joyner, DNP, FNP-BC, APRN

World Heart Day, 2023 (Image courtesy World Heart Federation)

Cardiovascular disease is the top cause of death worldwide. September 29th is World Heart Day, a global day of awareness and call to action against a disease that kills more than 20.5 million people per year. Quitting smoking is the single most preventable cause of heart disease and an important public health target.

Back in February, we did a blog post on the impact of smoking on heart health. Smokers are up to 4x more likely to develop heart disease or have a stroke, compared to nonsmokers, according to the Centers for Disease Control and Prevention (CDC).

Figure courtesy Münzel, et al, Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes, European Heart Journal, Volume 41, Issue 41, 1 November 2020, https://doi.org/10.1093/eurheartj/ehaa460. Available under Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)

While rates of cigarette use have been steadily declining in the U.S., rates of daily e-cigarette use continue to increase—especially among youth. According to the most recent National Youth Tobacco Survey in 2022, more than 2.5 million high school and middle school students used e-cigarettes with more than 25% reporting daily use.

Part of the reason for their popularity is that e-cigarettes have been marketed and viewed by many who use them as a “safe” alternative to smoking. However, evidence is mounting that e-cigarette use can cause harm. The American Heart Association recently released a scientific statement detailing the negative impact of electronic nicotine delivery systems (ENDS)—that’s e-cigarettes and vapes—on the cardiopulmonary system.

Click here to read the full report. A few highlights:

Overview of mechanisms by which electronic cigarette use might cause acute cardiovascular events Solid lines indicate known pathways. Dashed lines indicate pathways of concern, but for which there are no empirical data for confirmation. Figure courtesy Benowitz NL, Fraiman JB. Cardiovascular effects of electronic cigarettes. Nat Rev Cardiol. 2017 Aug;14(8):447-456. doi: 10.1038/nrcardio.2017.36

• Nicotine, which is highly addictive, is found in many ENDS, but not all ENDS contain nicotine.

• The non-nicotine components of ENDS—flavorings, glycerol or propylene glycol, and metals (from the heating coil)—have been shown to cause heart and lung toxicity in animal and in vitro studies.

• Nicotine in ENDS stimulates the sympathetic nervous system and over time can lead to cardiac remodeling, causing heart failure and abnormal heart rhythms. It also causes vasoconstriction of blood vessels, leading to elevated blood pressure and delayed wound healing.

• More research on the long-term impacts of ENDS use on the cardiovascular system are needed, but short-term studies show harm.

To learn more about the negative impact of e-cigarette use on heart health, sign up for one of our upcoming trainings by visiting https://www.dukeunctts.com.

About the Author

Rachael Joyner, DNP, FNP-BC, APRN

Rachael Joyner, DNP, FNP-BC, APRN, is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certificate in Tobacco Treatment Practice and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.